Portal to Progress

Health Information Exchange is Entryway to Transparent Pricing and Better Care

With the cost of health care rising nationally, policymakers in many states like Montana are searching for solutions.

This includes health care cost transparency. At the heart of the transparency discussion is the need to provide consumers with more useful information to make smarter decisions based on cost and quality of elective services.

While many states have opted for expensive and unwieldy All Payer Claims Databases (APCD), a better approach to improving the quality and affordability of health care has been gaining significant traction in Montana. It’s called a Health Information Exchange (HIE), and because it contains both real-time clinical and claims information, it has proven to unlock better patient outcomes and a lower total cost.

Simply put, an HIE is a secure repository and conduit to electronically integrate patient and population health information from different provider and payer systems. The ideal result is a well-connected exchange where physicians have access to a patient’s true medical history the minute they walk through the door, and where insurers and other payers like Medicare and Medicaid can pair clinical and claims data to develop value-based care programs.

 

The HIE provides consumers and physicians with actionable personal health information that helps patients take control of their care with transparent cost and quality data.

Blue Cross and Blue Shield of Montana (BCBSMT), in partnership with the Montana Medical Association (MMA) and a two-year grant from the Montana Healthcare Foundation, have formed a pilot HIE program in Billings with the Billings Clinic, St. Vincent Healthcare, and Riverstone Health. The goal is to take the success of the pilot statewide.

“The MMA has been holding collaborative public and private stakeholder discussions about the development of a statewide Health Information Exchange,” said Jean Branscum, Chief Executive Officer of the MMA. “This is a great solution for Montana because, unlike an APCD, an HIE contains both claims and clinical information in one place. When providers and consumers have this information at their fingertips, the speed, quality, safety and affordability of patient care is improved.”

The Billings pilot HIE has been spurred on by the resounding success of an HIE in Oklahoma called My Health Access Network, led by Dr. David Kendrick.

“At BCBSMT, our goal is to provide the patient with the right care, in the right place, at the right time,” said John Doran, Divisional Vice President of External Affairs and Chief of Staff. “The HIE provides consumers and physicians with actionable personal health information that helps patients take control of their care with transparent cost and quality data. It really gives the consumer and the physician all the pieces of the puzzle they need to make smart decisions.”